Getting through labor is one of the most anticipated events during a woman's pregnancy. To avoid complications during labor, thorough assessment should be conducted by the health care providers early during the woman's pregnancy.
Uterine Rupture
•Uterine rupture is a rare but serious complication.
•Uterine rupture is a condition wherein the uterus cannot sustain the strain that it underwent.
•Factors that contribute to uterine rupture are abnormal presentation, prolonged labor, multiple gestation, improper use of oxytocin, and traumatic effects of forceps use or traction.
•Fetal death can be avoided in uterine rupture if immediate cesarean birth can be performed.
•Symptoms that a woman may feel preceding rupture are a sudden, severe pain during alabor contraction or a tearing sensation.
•Rupture can be complete or incomplete.
•With complete uterine rupture, the rupture goes through the endometrium, myometrium, and peritoneum, and then the contractions would immediately stop.
•With incomplete uterine rupture, the rupture only goes through the endometrium and the myometrium only, with the peritoneum still intact.
•Symptoms of complete uterine rupture include hemorrhage, shock, fading fetal heart sounds, distinct swellings of the retracted uterus and extrauterine fetus.
•For incomplete rupture, there is localized tenderness, persistent aching pain in the lower uterine segment, and lack of contractions and fetal heart sounds.
•Confirmatory diagnosis of uterine rupture can be revealed through ultrasound.
•Administration of emergency fluid replacement as ordered should be anticipated as well as IV oxytocin.
•Laparotomy would be performed to control the bleeding and repair the rupture.
•Cesarean hysterectomy or tubal ligation can also be performed with consent from the patient to remove the damaged uterus and remove the childbearing activity of the woman.
•Fetal outcome, the woman's safety, and the extent of the surgery must be revealed to the patient and allow time for them to express their emotions.
•The woman would be advised not to conceive again after a rupture of the uterus unless the rupture is in the inactive lower segment.
•The viability of the fetus and the woman's prognosis depends on the extent of the rupture.
Inversion of the Uterus
•Uterine inversion occurs when the uterus turns inside out due to the delivery of the fetus or the placenta.
•Factors that contribute to inversion are application of traction to the umbilical cord to remove the placenta, if pressure is applied to the uterine fundus when the uterus is not contracting, or if the placenta is attached to the fundus so during birth the fundus pulls it down.
•Signs of inversion include sudden gush of a large amount of blood from the vagina, a non-palpable fundus, signs of blood loss such as hypotension, dizziness, and paleness, and if bleeding continues, exsanguinations.
•The inversion should never be replaced and the placenta, if still attached, should never be removed.
•Administration of oxytoxic drugs could only worsen the inversion and make the uterus tense so that it is difficult to replace.
•To manage uterine inversion, an IV line with a large-gauge needle should be established to restore fluid volume, oxygen administration should be started, assessment of vital signs, and cardiopulmonary resuscitation if the woman undergoes arrest.
